Parent Flat Rate Program Opt-Out Form
Please complete this form if you are a parent/guardian who enrolled in the Parent Flat Rate program to transport your child to school and receive the School District of Philadelphia stipend but have changed your mind.

Please Note: It will take up to 14 business days for your student to be returned to a transportation route. Until you receive confirmation from the School District of Philadelphia Department of Transportation, please continue to transport your child to and from your school
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Do you want to withdraw from the Parent Flat Rate Program? *
Please Note: By selecting "Yes" you will no longer be eligible for the monthly $150 payment
Parent/Guardian First Name *
Parent/Guardian Last Name *
Student First Name *
Student Last Name *
Student's Date of Birth *
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Student's Current School - Please use the drop down box to select the school your child will be enrolled at for the 2020-21 school year. *
Student's Grade Level - Please select the grade level your child will be enrolled in for the 2020-21 school year. *
Student ID - The Student ID number can be found on the upper right corner of the notification letter that was mailed to you. If you do not have the notification letter, please contact your school.
Do you have another student that you would like to opt out of this program? *
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